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my wife and daughter were supposed to attend a performance of the little mermaid put on by the local philharmonic this saturday at the kodak center. just found out it was canceled due to the virus. they are supposed to have sesame street live in the same place in a few weeks, so i'm assuming that's canceled too. not a big deal to cancel either, but as far as i'm aware, there's not a single reported case of the virus in the area.

on a similar note, i spoke with a patient today who has kids in college in ohio and pennsylvania. they warned each student to bring their study materials home with them as they may actually make the decision that the kids don't come back. they'll try to do the online thing for the rest of the semester.

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This graph is the answer to everyone who posts somewhere about "why don't we just all accept that we're going to get the disease, accept the mild symptoms most of us will have, and get it over with?"

This is the classic "contained vs uncontrolled transmission" epidemic graph.

If 80% have a mild disease, but ~15% are seriously ill and require medical intervention including oxygen and ~5% become severely ill and require intensive care, hospitals and HCW quickly become overwhelmed. This is undoubtedly part of the high initial death rate in Wuhan - the healthcare system, despite redeployment of resources from other parts of the country, was simply too far above capacity. (Oh, and be sure to schedule your heart attack or your meningitis so that it doesn't occur at the epidemic peak.)

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my wife and daughter were supposed to attend a performance of the little mermaid put on by the local philharmonic this saturday at the kodak center. just found out it was canceled due to the virus. they are supposed to have sesame street live in the same place in a few weeks, so i'm assuming that's canceled too. not a big deal to cancel either, but as far as i'm aware, there's not a single reported case of the virus in the area.

Teef, please allow me to reprise something I said upthread with some emphasis:

"Anyone want to bet the rent that if there's community spread in Snohomish, Washington originating from travel mid-December to mid-January, there is not already community spread elsewhere in the country? I don't. (Yes, there are caveats here, but do we want to bet the low probabilities vs an emerging epidemic...?)

Why don't we know that there's community transmission underway all over the country? Until this week, testing was 100% focused on returning travel from known infected places because the "case definition" included these. Seriously. If you hadn't traveled but had symptoms, you couldn't be tested (...). Meanwhile, places like Taiwan "get it": "they proactively sought out patients with severe respiratory symptoms based on records in the national health insurance (something which all developed countries can deploy with relative ease, with the notable exception of the US [my note: but we could still do it, just harder])." Meanwhile, In US, people in hospital with severe respiratory symptoms who tested negative for flu were NOT being tested for Covid19. Even a nurse who became ill with respiratory symptoms AFTER CARING FOR A KNOWN COVID19 PATIENT in CA struggled to get tested - and this is a critical test, because if a HCP falls ill caring for a patient, it's a Red Alert that the infection control protocol needs revision. "

It is my belief (but to my knowledge, this belief is shared by actual epidemiologists) that we probably have community spread underway in many parts of the country, undetected because we have not been testing and contact-tracing patients with severe respiratory symptoms (especially those who test negative for influenza) who may have traveled or been in contact with someone who traveled in late Decembe to mid January - the question asked is "travel in last 30 days" which at this point, means back to early February.

Where we don't have community spread actually underway, we almost certainly have someone who has been exposed to the virus in the latent stage able to transmit to any large gathering.

Make sense?

Quote

on a similar note, i spoke with a patient today who has kids in college in ohio and pennsylvania. they warned each student to bring their study materials home with them as they may actually make the decision that the kids don't come back. they'll try to do the online thing for the rest of the semester.

TBH, what colleges really should do is ask everyone to cancel their spring break travel, but where colleges aren't yet having a problem, after kids go home then return they are almost certain to bring the disease with them. 20 colleges and counting have canceled F2F classes and gone to "online only" formats (including Stanford, Columbia, Fordham, Rice, USC, Hofstra, U of Washington, and Princeton), which is fine but what about laboratory courses? And will the kids remain on campus collecting in dorms and cafeterias? Lots of unknowns.

Francois Balloux of the University College London Genetics Institute said: “The trajectory in the UK is so far roughly comparable to the one in northern Italy, but with the epidemic [there] two to three weeks ahead of the situation [here].

“It is possible that a lockdown strategy similar to the one imposed in northern Italy may be adopted by the UK. The Covid-19 epidemic cannot be contained any more.”

Doctor-turned-author Adam Kay said it should be a stark warning for Britain. He said: “­Fourteen days ago, Italy had fewer coronavirus cases than we do today. They employed similar public health measures to us.

"There are no more surgeons, urologists, orthopaedists – we are only doctors who have become part of a single team to face this tsunami that has overwhelmed us.

"Cases are multiplying, with a rate of 15-20 admissions per day – all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the ER is collapsing. Reasons for admission are always the same: fever and breathing difficulties, fever and cough, respiratory failure.

"Radiology reports are always the same: bilateral interstitial pneumonia. All to be hospitalised.

"Some are already intubated go to intensive care. For others it’s too late. Ventilators are like gold dust: those in operating theatres that have suspended non-urgent activity become intensive care places that did not exist before.
(....)

"There are no more shifts, no more hours. Social life is suspended. We no longer see our families for fear of infecting them. Some of us have already become infected despite the protocols. "Some infected colleagues have infected relatives, some of whom are already fighting for their lives.

"So be patient – you can’t go to the theatre, museums or the gym. Try to have pity on the myriad of old people you could exterminate.

"We try to make ourselves useful. You should, too. We influence the life and death of a few dozen people. You, many more. Please share this."

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The amount of ignorance surrounding COVID-19 right now is stunning and infuriating.

If I hear "it's less deadly than the flu!" or "this is just media-created hype over nothing" ONE MORE TIME... 🤬"

I get it: Its a frightening reality and in order to attempt to assuage their own fear -- which most of them won't even admit they're feeling -- many people downplay the seriousness and potential risk of the virus. If that's how you want to think of the thing in your own mind, fine. But please, PLEASE...don't go around spouting that factually incorrect, downright dangerous disinformation within earshot of other people who are foolish enough to actually believe it.

I will refrain from saying the rest of what I'd like to say about this virus and our federal government's reaction to it or lack thereof, for there would be no way to avoid it become political.

I agree, if people only knew how much open borders and fighting travel bans would help the CoronaVirus!

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Teef, please allow me to reprise something I said upthread with some emphasis:

"Anyone want to bet the rent that if there's community spread in Snohomish, Washington originating from travel mid-December to mid-January, there is not already community spread elsewhere in the country? I don't. (Yes, there are caveats here, but do we want to bet the low probabilities vs an emerging epidemic...?)

Why don't we know that there's community transmission underway all over the country? Until this week, testing was 100% focused on returning travel from known infected places because the "case definition" included these. Seriously. If you hadn't traveled but had symptoms, you couldn't be tested (...). Meanwhile, places like Taiwan "get it": "they proactively sought out patients with severe respiratory symptoms based on records in the national health insurance (something which all developed countries can deploy with relative ease, with the notable exception of the US [my note: but we could still do it, just harder])." Meanwhile, In US, people in hospital with severe respiratory symptoms who tested negative for flu were NOT being tested for Covid19. Even a nurse who became ill with respiratory symptoms AFTER CARING FOR A KNOWN COVID19 PATIENT in CA struggled to get tested - and this is a critical test, because if a HCP falls ill caring for a patient, it's a Red Alert that the infection control protocol needs revision. "

It is my belief (but to my knowledge, this belief is shared by actual epidemiologists) that we probably have community spread underway in many parts of the country, undetected because we have not been testing and contact-tracing patients with severe respiratory symptoms (especially those who test negative for influenza) who may have traveled or been in contact with someone who traveled in late Decembe to mid January - the question asked is "travel in last 30 days" which at this point, means back to early February.

Where we don't have community spread actually underway, we almost certainly have someone who has been exposed to the virus in the latent stage able to transmit to any large gathering.

Make sense?

TBH, what colleges really should do is ask everyone to cancel their spring break travel, but where colleges aren't yet having a problem, after kids go home then return they are almost certain to bring the disease with them. 20 colleges and counting have canceled F2F classes and gone to "online only" formats (including Stanford, Columbia, Fordham, Rice, USC, Hofstra, U of Washington, and Princeton), which is fine but what about laboratory courses? And will the kids remain on campus collecting in dorms and cafeterias? Lots of unknowns.

great points. i'm all for the proactive prevention attempts. this is just the first time it's become, "real" in this area. our friend works for the local ahl hockey team, and she thinks there's going to be a decision by the end of this week as to whether fans are allowed back to watch the games.

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oh, it went from 5 to 6 people, that’s a leap of 20%, so many more facets to add to the picture to get it to be factual and real
my day includes people who believe the whole thing is a hoax and people who believe we will all die by June

2. why the death rate is so much lower in S. Korea - it's not because of more testing or more accuracy, it's because of aggressive contact tracing and testing and quarantine, keeping illness below the capacity of hospitals to optimally treat

3. why the death rate in China now is so much lower than it was in Wuhan - for the same reason

4. why the death rate in Italy is so high - the hospitals are overwhelmed and literally making life or death decisions. We will be there too if we don't act, the disease doesn't care about your politics. Its. A. Virus.

5. it gives factual examples of what happened in the 1918 flu in cities that took immediate social distancing measures (St Louis) vs those that did not (Philidelphia)

To dismiss that whole article as guesswork because you don't understand what epidemiologists do (hint: it is highly educated guesswork and usually quite accurate) is your choice, but IMHO it is foolish. Very foolish.

Please keep in mind that I am a "trained Maniac", not an epidemiologist nor a virologist but a highly-trained scientist who has worked with both.